Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


An overview of the epidemiology, risk factors, clinical manifestations, and management of pelvic organ prolapse in women

INTRODUCTION

Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, is a common condition. Many women with prolapse experience symptoms that impact daily activities, sexual function, and exercise. The presence of POP can have a detrimental impact on body image and sexuality [1]. Treatment of POP requires significant health care resources; the annual cost of ambulatory care of pelvic floor disorders in the United States from 2005 to 2006 was almost $300 million [2] and surgical repair of prolapse was the most common inpatient procedure performed in women older than 70 years from 1979 to 2006 [3]. The health care impact of prolapse is likely to expand, based upon estimates of an increasing prevalence in the growing population of elderly women [4].

The epidemiology, risk factors, clinical manifestations, and general principles of management are reviewed here. Management of prolapse with vaginal pessaries and choosing a primary surgical procedure for prolapse repair are discussed separately. (See "Vaginal pessary treatment of prolapse and incontinence" and "Pelvic organ prolapse in women: Choosing a primary surgical procedure".)

TERMINOLOGY

Pelvic organ prolapse (POP) – The herniation of the pelvic organs to or beyond the vaginal walls.

Commonly used terms to describe specific sites of female genital prolapse include:

Anterior compartment prolapse – Hernia of anterior vaginal wall often associated with descent of the bladder (cystocele) (figure 1).

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: Sep 25, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Lowder JL, Ghetti C, Nikolajski C, et al. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol 2011; 204:441.e1.
  2. Sung VW, Washington B, Raker CA. Costs of ambulatory care related to female pelvic floor disorders in the United States. Am J Obstet Gynecol 2010; 202:483.e1.
  3. Oliphant SS, Jones KA, Wang L, et al. Trends over time with commonly performed obstetric and gynecologic inpatient procedures. Obstet Gynecol 2010; 116:926.
  4. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol 2009; 114:1278.
  5. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175:10.
  6. Kenton K, Shott S, Brubaker L. Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8:336.
  7. Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol 2006; 194:1438.
  8. Stepp, KJ, Walters, MD. Anatomy of the lower urinary tract, rectum and pelvic floor. In: Urogynecology and Reconstructive Surgery, 3rd ed, Walters, M, Karram, M (Eds), Mosby, Philadelphia 2007. p. 24.
  9. Barber MD. Contemporary views on female pelvic anatomy. Cleve Clin J Med 2005; 72 Suppl 4:S3.
  10. Stepp, KJ, Walters, MD. Anatomy of the lower urinary tract, rectum, and pelvic floor. In: Urogynecology and Reconstructive Pelvic Surgery, 3rd ed., Walters, MD, Karram, MM (Eds), Mosby Elsevier, Philadelphia 2007. p.27.
  11. Percy JP, Neill ME, Swash M, Parks AG. Electrophysiological study of motor nerve supply of pelvic floor. Lancet 1981; 1:16.
  12. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 2013; 24:1783.
  13. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008; 300:1311.
  14. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 2005; 193:103.
  15. Tegerstedt G, Maehle-Schmidt M, Nyrén O, Hammarström M. Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:497.
  16. Rortveit G, Brown JS, Thom DH, et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 2007; 109:1396.
  17. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol 2003; 188:108.
  18. Jones KA, Shepherd JP, Oliphant SS, et al. Trends in inpatient prolapse procedures in the United States, 1979-2006. Am J Obstet Gynecol 2010; 202:501.e1.
  19. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89:501.
  20. Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 2010; 116:1096.
  21. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol 2000; 183:277.
  22. Hendrix SL, Clark A, Nygaard I, et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186:1160.
  23. Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 1999; 180:299.
  24. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007; 369:1027.
  25. Sze EH, Sherard GB 3rd, Dolezal JM. Pregnancy, labor, delivery, and pelvic organ prolapse. Obstet Gynecol 2002; 100:981.
  26. Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 1997; 104:579.
  27. Patel DA, Xu X, Thomason AD, et al. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 2006; 195:23.
  28. Tinelli A, Malvasi A, Rahimi S, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause 2010; 17:204.
  29. Swift S, Woodman P, O'Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192:795.
  30. Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol 2009; 113:81.
  31. Daucher, JA, Ellison, RE, Lowder, JL. Pelvic support and urinary function improve in women after surgically induced weight reduction. Female Pelv Med & Reconstr Surg 2010; 16:263.
  32. Whitcomb EL, Rortveit G, Brown JS, et al. Racial differences in pelvic organ prolapse. Obstet Gynecol 2009; 114:1271.
  33. Sears CL, Wright J, O'Brien J, et al. The racial distribution of female pelvic floor disorders in an equal access health care system. J Urol 2009; 181:187.
  34. Weber AM, Walters MD, Ballard LA, et al. Posterior vaginal prolapse and bowel function. Am J Obstet Gynecol 1998; 179:1446.
  35. Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol 1994; 101:147.
  36. Jørgensen S, Hein HO, Gyntelberg F. Heavy lifting at work and risk of genital prolapse and herniated lumbar disc in assistant nurses. Occup Med (Lond) 1994; 44:47.
  37. Carley ME, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome. Am J Obstet Gynecol 2000; 182:1021.
  38. Muir TW, Aspera AM, Rackley RR, Walters MD. Recurrent pelvic organ prolapse in a woman with bladder exstrophy: a case report of surgical management and review of the literature. Int Urogynecol J Pelvic Floor Dysfunct 2004; 15:436.
  39. McIntosh LJ, Mallett VT, Frahm JD, et al. Gynecologic disorders in women with Ehlers-Danlos syndrome. J Soc Gynecol Investig 1995; 2:559.
  40. Lince SL, van Kempen LC, Vierhout ME, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J 2012; 23:1327.
  41. Ward RM, Velez Edwards DR, Edwards T, et al. Genetic epidemiology of pelvic organ prolapse: a systematic review. Am J Obstet Gynecol 2014; 211:326.
  42. Handa VL, Jones M. Do pessaries prevent the progression of pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct 2002; 13:349.
  43. Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev 2010; :CD007063.
  44. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 2003; 189:372.
  45. Heit M, Rosenquist C, Culligan P, et al. Predicting treatment choice for patients with pelvic organ prolapse. Obstet Gynecol 2003; 101:1279.
  46. Ellerkmann RM, Cundiff GW, Melick CF, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 2001; 185:1332.
  47. Gutman RE, Ford DE, Quiroz LH, et al. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol 2008; 199:683.e1.
  48. Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:122.
  49. Kahn MA, Breitkopf CR, Valley MT, et al. Pelvic Organ Support Study (POSST) and bowel symptoms: straining at stool is associated with perineal and anterior vaginal descent in a general gynecologic population. Am J Obstet Gynecol 2005; 192:1516.
  50. Klingele CJ, Bharucha AE, Fletcher JG, et al. Pelvic organ prolapse in defecatory disorders. Obstet Gynecol 2005; 106:315.
  51. Tan JS, Lukacz ES, Menefee SA, et al. Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:203.
  52. Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol 2005; 106:759.
  53. Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol 2006; 195:942.
  54. Marinkovic SP, Stanton SL. Incontinence and voiding difficulties associated with prolapse. J Urol 2004; 171:1021.
  55. Patil A, Duckett JR. Effect of prolapse repair on voiding and bladder overactivity. Curr Opin Obstet Gynecol 2010; 22:399.
  56. de Boer TA, Salvatore S, Cardozo L, et al. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn 2010; 29:30.
  57. Burrows LJ, Meyn LA, Walters MD, Weber AM. Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 2004; 104:982.
  58. Tok EC, Yasa O, Ertunc D, et al. The effect of pelvic organ prolapse on sexual function in a general cohort of women. J Sex Med 2010; 7:3957.
  59. Weber AM, Walters MD, Piedmonte MR. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2000; 182:1610.
  60. Weber AM, Walters MD, Schover LR, Mitchinson A. Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol 1995; 85:483.
  61. Barber MD, Visco AG, Wyman JF, et al. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 2002; 99:281.
  62. Novi JM, Jeronis S, Morgan MA, Arya LA. Sexual function in women with pelvic organ prolapse compared to women without pelvic organ prolapse. J Urol 2005; 173:1669.
  63. Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol 2007; 109:848.
  64. Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 2004; 190:27.
  65. Dietz HP. Prolapse worsens with age, doesn't it? Aust N Z J Obstet Gynaecol 2008; 48:587.
  66. Elkadry EA, Kenton KS, FitzGerald MP, et al. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 2003; 189:1551.
  67. Hullfish KL, Bovbjerg VE, Steers WD. Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up. Am J Obstet Gynecol 2004; 191:201.
  68. Mahajan ST, Elkadry EA, Kenton KS, et al. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol 2006; 194:722.
  69. Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol 2012; 119:852.
  70. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011; :CD003882.
  71. Braekken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol 2010; 203:170.e1.
  72. Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet 2014; 383:796.
  73. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 2004; 191:1533.
  74. Daskalakis G, Lymberopoulos E, Anastasakis E, et al. Uterine prolapse complicating pregnancy. Arch Gynecol Obstet 2007; 276:391.
  75. Tsikouras P, Dafopoulos A, Vrachnis N, et al. Uterine prolapse in pregnancy: risk factors, complications and management. J Matern Fetal Neonatal Med 2014; 27:297.